Permit QA.pri (T.ULd ) -t-c, Qdd C►) 3 ( u 4- (2-) c k .
CITY OF TIGARD ELECTRICAL PERMIT
14 ;" COMMUNITY DEVELOPMENT Permit #: MST2009 -00079
13125 SW Hall Blvd. Tigard OR 97223 503.639.4171 Date Issued: 02/18/2009
T��"°' Parcel: 2S102DC01900
Jurisdiction: TIG
Site address: 9300 SW EDGEWOOD ST
Subdivision: Lot:
Project: SIMMONS
Project Description: Additional 520 sq ft accessory structure. 10/9/09 ADDED 100 amp sub panel and (2) branch
circuits.
Owner: FEES
CRAIG SIMMONS Quantity Description Date Amount
9300 SW EDGEWOOD ST
TIGARD, OR 97223 1 [BUILD] Bldg Permit 02/18/2009 $257.44
1 [BUPPLNI PIn Rv Balance 02/18/2009 $167.34
PHONE: 503 - 524 -3488 1 [TAX] Build 12% State 02/18/2009 $30.89
Surchrge
Contractor: 1 [CDCPLN] CDC Pln Rev 02/18/2009 $46.00
1 [LRPF] LR Planning 02/18/2009 $6.00
Surcharge
1 [PLUMB] PLM Permit 02/18/2009 $72.50
1 [TAX] PLM 12% State 02/18/2009 $8.70
PHONE: Surcharge '
FAX: 1 [ELPRMT] ELC Permit 02/18/2009 $60.15
1 [TAX] ELC 12% State 02/18/2009 $7.22
Surcharge
1 [ ERPRMT] Erosion Control 02/18/2009 $26.00
Type of Use: SF 1 [ERPLNI Erosn Pln Rv CWS 02/18/2009 $8.45
Class of Work: ACS Type of Const: 5N 1 [EROSN] Erosn Pln Rv COT 02/18/2009 $8.45
Occupancy Grp: R3 63 da Additional Plan Review 08/20/2009 $62.50
1 ea Services or Feeders - 200 10/09/2009 $80.30
amps or less
2 crt Branch Circuits w /Purchase 10/09/2009 $13.30
Service or Feeder
11 da 12% State Surcharge - 10/09/2009 $11.23
Electrical (manual)
Total $866.47
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 orr .P V ' 11 y .800.332.2344. /�
Issued By: 6 Permittee Signature: S Q Y (C.(11 0 0
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
t
I
IIN _,.,46 n CITY OF TIGARD
PERMIT
ERM #: MST2009 -00079
° COMMUNITY DEVELOPMENT DATE P ISSUE D: 2/18/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102 DC - 01900
SITE ADDRESS: 09300 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 015 JURISDICTION: TIG
PROJECT: SIMMONS
Project Description: Additional 520 sq ft accessory structure.
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: 12 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: N
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 520 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 19,614.40 REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 2 SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATAfTELE COMM: NURSE CALLS: TOTAL N SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
CRAIG SIMMONS OWNER laws. All work will be done in accordance with approved plans. This
9300 SW EDGEWOOD ST permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 001 -0010
through 952- 001 -0080. You may obtain copies of these rules or direct
Phone: 503 -524 -3488 Contact #: questions to OUNC by calling 503.246.6699 or 1 800.332.2344.
Reg #:
TOTAL FEES: $ 699.14
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Issued By : ` i il e' I be,. 1 1 1 • Permittee Signature : .!�.cc
(
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential ��� D Rec eived FOR OFFICE USE,ONLY
City of Tigard �, 1$,
Date/B : l
IN
i • ` Pe No 2oi , . • 0 9
q 13125 SW Hall Blvd., Tigard, OR 97223
-
Tigard, 2009 Plan Review ► ��
- Phone: 503.639.4171 Fax: 503.598 1960 FEB 1 $ Date /B : 1�jV�♦ .I /,� Other Permit:
TI GA RD Inspection Line. 503.639 �.� Dat Ready /By: 7u s: ® See Page 2 for
Internet: www.tigard -or gov �r Notified/Method: 11 G Supplemental Information
CI OF 1�G
TYPE OF w 1iDINC
REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1 -and 2- family dwelling Valuation: $ %9 ( /� 0
❑ Commercial /industrial [
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
. JOB SITE. INFORMATION AND LOCATION Total number of floors:
Job site address: 7 & c) 6 Z e us( 4 4 ,5 4- New dwelling area: square feet
City /State /ZIP: I I t ,t-d, OR_ 7 a a 3 Garage /carport area: 59,0 square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: () Ph,0.,� Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
, DESCRIPTION OF WORK- work indicated on this application.
A ck}-L 0-4 €4,S4 :1- ��'o e- e€ 9, 4 64- t 10,1 Valuation: $ (� I 4 (0
�/' e � /ar�Ce. 6 . Existing building area: square feet
+ [ New building area: square feet
}.PROPERTY OWNER • . ❑ .TENANT Number of stories:
Name: Lk ri yo -,,, f Type of construction:
Address: g3 co S W c4 Occupancy y groups:
City /State /ZIP: 'id.o- C 94 Q? .i3 Existing:
Phone: (9 ) .s'aH - 3 y ks, Fax: ( ) New:
• ❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: , All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( )
E -mail:
CONTRACTOR
Business name: • BUILDING PERMIT FEES *'
Address:
Cpui\-e-( (Please refer to fee schedule)
Structural plan review fee (or deposit):
City/State /ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
f %� �` ` "�1� within 180 days after it has been accepted as complete.
Print name: ( � n e r; � v . . /5,44 3 Date: /` s/ f * Fee methodology set by Tri- County Building Industry
c � 6 Service Board.
I: \Buildmg\Permits \BUP -RES PennitApp.doc 11/6/07 440- 4613T(I I /02 /COM/WEB)
Building Permit Application Checklist
One- and Two- Family Dwelling t.. "FOR
'OFFICE USE ONLY
City of Tigard Received Permit No.:
II Date /By:
U 13125 SW Hall Blvd., Tigard, OR 97223
Phone. 503.639 4171 Fax. 503.598.1960 Associated permits.
24- Hour Inspection Line: 503.639.4175 ' 4 ' ,, ❑ Electrical , ❑ Plumbing ❑ Mechanical
T 1 G A R D;
. Internet. www.tigard- or.gov ❑ Other:
1 THE FOLLOWING, ITEMS ARE REQUIRED FOR PLAN REVIEW' : ' Yes - No ' N/
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ Cl ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ El El
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ El
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ El El
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ El
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ El
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ El
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals): location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage: impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ El ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- Cl ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ El ❑
over 10 feet long and /or any beam/joist carrying a non- uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ El
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ El El
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ El
.
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS, . , . I
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ El
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ El El
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, • ❑ ❑ El
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
1 \ Building \Permits \BUP- RES- PermitApp doc 03121/06 440- 4613T(11 /02 /COM/WEB)
Plumbing Permit Application .
Building Fixtures FOR OFFICE USE. ONLY
R eceived fl 7 � _ o � 77
City of Tigard Permit No : 0`
V 13125 SW Hall Blvd., Tigard, OR 97223
71
_ Date/By:
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 , , , Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK • _ FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler (_ sq. ft.) Page 2
JOB SITE. INFORMATION, AND ,LOCATION Site utilities
Job site address: cis 6� eta (x)8 ..71.- Catch basin or area drain 16.60
City /State /ZIP: -"- c ® f r ,,,3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft : 4 ,(20( Page 2 C. •6
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
.. Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK " ` - Backflow preventer Page 2
a A R("0._∎ llS Backwater valve 16.60 • 4
11" x `""" lam
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
: " . , .1ROPERTY OWNER ' (, ❑ TENANT`
Ejectors /sump 16.60
Name: ■. , V": ,;, t' Ss' Expansion tank 16,60
Address: U e(3 5c_ I v a .. ic ( / Fixture /sewer cap 1 6.60
City /State /ZIP: l U Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( )
Garbage disposal 16.60
. ❑ APPLICANT - ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
. C ONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Wf V �.... /f Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 72,s---6
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: Plumbing Lic. no.:
Plan review (25% of permit fee) �8-
State surcharge (12% of permit fee) 7 a
Authorized signature: TOTAL PERMIT FEE kl
Print name: � .,<,\ 1V, a S Date:,// kier This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(t0 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
S1tC >UtilitieS A fi t _ Qt x Fee (ea):' Total Square FootagC 1: Permit. Fee:
Footing drain - 1s 100' 55.00 0 to 2',000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220 00
Sewer - 1st 100' • 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: ..� • Pe>rmit,F
Storm & Rain Drain - 1st 100' 55.00 .
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
`I+'iXlEI= additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379 50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work: P l a n, Reviewti-for Installations -�
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: - . . Replace engineer.
- ''Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall El Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain :: Isometric or RiSer'Diagrain " ,
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i \Building\Permits\PLM- PermitApp doc 12/27/06
Electrical Permit A • • I ,,, ,t, � FOR OFFICE USE,ONLY ° •
City of Tigard Received ! /'.
00 9 D ate /By: Permit No.: AA y'a(m'q r — am , `/
NI
7 q 13125 SW Hall Blvd., Tigard, OR2�38 2 '
.
tt P lan Review Other Permit.
Phone: 503.639.4171 Fax: Sd3." .1 60 Date/By:
T I GAR D Inspection Line: 503.639.4175 VIG� Date Ready /By: Juris: 0 See Page 2 for
Internet: www.tigard - or.gov Cut' 0 n Notified/Method: Supplemental Information
.. T I ! ' .. .. PLAN ,REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
:JOB' SITE INFORMATION' AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l - ", "I - ",
Job no.: Job site address: CiS� 6 I Six or or more. occupancy. R Recreational t'et.z Y'xr S ❑ Six or more residential units. El ecreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
T; c>r� C �� 9 t,. a3 ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
' ' FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
, Li m gy, residential
. DES CRIPTION- OF WORK above sq. ftre.) 75.00 2
Oa Limited energy, multi - family 75.00 2
rI e _ r C -. ¶ C e.. f J ,'f N -fur S4 g cxr i e N PeAS residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' J PROPERTY OWNER .❑ TENANT; 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: �,1,_ ; 6, as 601 amps to 1,000 amps 240.60 2
Address:
C r( ?C S er e ,0 Fi , Over 1,000 amps or volts 454.65 2
J emporary services or feeders installation, alteration, and/or
City/State /ZIP: —`
Tt�c�f - A OR C l ?a relocation
Phone: ( $D3) 5-0/-3/ 8 Fax: ( ) 200 amps or less 66.85 1
Owner installation: TL inst lation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, ent, exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: - Gr�r��� -7„," Date: A. Fee for branch circuits with
❑ APPLICANT . " ❑ CONTACT PERSON ab ove service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 0
Contact name: ( 46.85 16,: 2 em
first branch circuit
Address: Each.add'l branch circuit '�, 6.65 I'l . 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR: , Sign or outline lighting 53.40 2
Business name: Q //� , e _ Signal panel, or limited- ,
(� y l/ energy panel, alterattionon, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: () , I / C
Print name: Date: Plan review (25% of permit fee): -&--
State surcharge (12% of permit fee): 7. 9
Authorized signature: TOTAL PERMIT FEE: [ e i , '1,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp doe 05/23/06 440-46 15T( I 1 /05 /COM /WEB
Electrical Permit Application - City of Tigard - , • -
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r;RESIDENTI TAL WORK,ONLY:" ;' �'
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
j C ;OIVIMERCIAL WOR,K'ONLY: ° . -
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I \Building\Permits\ELC- PermitApp doc 03/23/06
This form is recognized by most Building Departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
: I ., BUILDING DIVISION
.
-
TIGARD TRANSMITTAL LETTER
a
TO: 1
---MCL-1"._ DATA&G,A,IfFn
DEPT: BUILDING DIVISION
AUG 20 2009
-)03- 7rq - 4h6
CITY OF TIGARD
FROM:
.......
Ci_h
6r 2-4 I (/_...44,11461- BUILDING DIVISION
COMPANY:
PHONE:
RE: '... -I • -- - .,.......TAN....m.,
--- :::L.A - -471 --- s .L.wduh-- ... .
(Site Address) *emu . - orrermv .
. 111.11.---- ‘,77260 — c 7'
•roJect name or su 1 e ivIsion name ans ot numeer
/ , I 0 S — 00 /0 q
ATTACHED ARE THE FOLLOWING ITEMS:
. eliiiii: :-,-:•=‘ :-,.: ,.,01:fil:0-i =',` /':.; . :W' . :,r,,'::
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other ;plain):
REMARKS: i t
di. • , 4:
,1
I)
1 ,
:2: :..,:,:,,:;,,;:::-:.,,;,, .,' .:: „,_.,':::;::$:',,,;.:::i.:,,:::,.;:::iiivogoimet.vstrom-c To:: ,' ,•:
Routed to Permit Technician: Date: Initials:
Fees Due: 0 Yes 0 No Fee Description: Amount Due:
$
, .. :: ., ' . ' , ' ' '''' $
$
$
$
- ,
. . , .
Special
Instructions: I
Reprint Permit (per PE): El Yes H No 0 Done
Applicant Notified: Date: Initials:
1:\BuildingTorrns\TransmittalLetter-Revisions doc 4/4/07
Pli
Information Notice to Owners About
" " ; i'' C onstruction Responsibilities
,::-,- (ORS 701.055 (5))
Homeowners acting as their own general contractors to construct a new home
• or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503 - 378 -4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503 - 947 -1488.
• Oregon's Business Identification Number (BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, call 503 - 945 -8091 or go to
http: / /www.oregon.gov /DOR /BUS /docs /211- 055.pdf for the appropriate forms.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 503 - 947 -7815.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, call the IRS at 1- 800 - 829 -4933 or visit their website at www.irs.gov. .
Other Responsibilities of Homeowners:
• Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough -in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309 -5052
Telephone: 503 - 378 -4621 — Fax: 503 - 373 -2007
Website Address: www.oregon.gov /ccb
f /property_owner adopted 12 -04 -07 This Copy for Permit Applicant
.Y
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
e rcitb-- St t ,.. An, b ,t-S
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
r, -
.A A I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
V4 ev 4 kiN C C 1 i vh vv\ -,
Print Nam of PermitAppl
& ( 8/ td)'
Signature of Permit Applicant Date
Permit #: C c a-z0 •C GS
Address: q ACK:. GckwC'l36 C :— Nivs
1 Coft•cd 1 oe Q72-3 ,
Issued by: Date: a - t 8. C 9
This Copy for Permit Offices
1 ,
RECEIVED .6
c
r ` W FEB 18 2009 iii
+ , - N - N � • ' 7 w , N - - N • ` � N � ` N �' 1�� . � _ CTf Y OF TIGARD U
• ���� "40 Jfj� ��`���:�l�■J����y� yt: o x
4.1h �,_ Jt�.. Ti . Jij If� ,Jtlt . 1. f;1,'.)t�. ¢ , M
IA N
0) N
\
C W
GENERAL Srsin NofES+ — — 7c ., 7c ., E c
I. TO QTY SEPTIC STSTB'1 IF REWIRE) \ 0
2 VERIFY C GRADES N M I AND Ream' ANY
EDGEWOOD STREET , Z 0 _°,
fD
DLSCREPANCIESANCIES TO DESIGNER BEFORE cWORK agNCING WORK
3. SEE ROOF PLAN FOR DRAIN AND DOW! SPOUT INFORMATION \ 11
ALL WORK SHALL BE CONSTRUCTED IN COMPLIANCE WITH ALL AFPI.IG eLe CODES. ( J
ANY ADVERSE CCNDITIONS SHALL BE REPORTED TO THE OWNER AND THE DESIGNER @
IMMEDIATELY. COORDINATE WRH LOCAL LMLMES FOR APPROPRIATE CONNECTIONS MB
AND PROVIDE COMPLETE 1 BID. CONTRACTOR I5 TO VERIFY IDr BOUNDARY LINE MB @
Alm ASSURE THAT THE BUILDING IS WITHIN A 1,41114 NY MINIMUM SETBACKS. EI MD •• Q W
E APPROXIMATE. oo
ELEVATIONS OF EXISTING AND CR awes RADES ARPRIATE DEVIADEVIATIONS SHALL BE RAINS — � .._.
REPORTED TO THE STING DESIGNER F-0R DETHd'EHA ARE AND AD ASTI' A ALL ROOF DRAINS
-- - — SHALL BE SEPARATE FROM FOOTING DRAINS AND SWILL BE EXTENDED TO GRADE IN A
MANNER THAT RILL NOT uusE EROSION aN NEGATIVELY MCI ADJACENT PROPERTY. 160.3 � � ■ r n
STRIP AND STALE TOP SOIL FOR FUTURE BACICFILL ALL DICES EXCAVATION MATERIAL �� V
Is TO BE REMOVED Mal NE SITE IF NECESSARY. �� — — —�� �',fi W
v\ r e 1 U_ CZ co
U m
CITY OF TIGARD - SITE PLAN REVIEW \ 0 J co
BUILDING PER MIT OD
NO: lyST
acb9 -oao 7 9 \ 44.. , Y 1„
N I <_
Street Trees: ❑ A \ Q w o
Approved ❑ Not Approved
Protected Trees: I \ ' J �,
Approved ❑Not Approved
t I
\ LtJ Z
B �' Date:.. \
ores:
Ku
\ 1 m0
LEGEND
1 --------;
/ 7,'; '/111 �''
i '/ / / A 0
O Set 5/8 inch by 30 inch iron rod I 7,&,,/,1 / \ Y P caP P� \ O ellow lactic stern i� j ' \ Property line %' i 1 ''` A Center Line % A
P.U.E. Public unlit easement ®L /of ` ! � \ , \
ELEV. - Elevation O I � i ^ 1 / ��/ /,, i : �/ 'D ��
C.O.T. -City of Tigvd / c. \
PWR - ELECTRIC POWER = % „ - .
WATER - CITY WATER UTILITIES SITE PLAN �� ,�'��' — -- -- , f \
CAN - CABLE T.V. / // M ; / / 1 , , Milli
' •. FIRE HYDRANT " / j � / 14 • j \ I
SCALE: 1 =20' / % ' _ lo o / w,u+Ezooe
I
// - DATE
FENCE LINE REVISED
' '�/}Ceysozy � %/ 26 , \
— — —CONTOUR LINES AT 2' INTERVALS �' GM t2JtT> j \ \
n
EXISTING BUILDING 1 %27,x// I PE.Pj 1 I e-k 1400f.... Life
W
U
th- o�
NEW BUILDING AREA I I Ex 1sT NC "Dtfpcit tr / ILDING PERM,. OF TIGARD GARD - SITE LAN R .VIEW z N
24.P..tr�� Gt�t•-ret $ B . )--4 cd ?�j o W o
��� P ANNING DIVISION: `� ' - Q O Z
� TU IL�
O
— 1 - 4 7 16 �i 1�
I�le Setbacks: 'Approved ❑ N .t Approved Q
EDGEWOOD AD D N. ___,L. Side: ___,L. I ❑ 2.-L___ Street Side: o o
Front. _? Gfi rage: 2 w o
.._4_ Rear: IS =
>uaI Clearance: N Approved I 0 Not Approved 1/4. � �— 2 Q u 5
CITY OF TIGARD { u Building H e h[
:;rm Buildi , H ° o Q
WASHINGTON COUNTRY /' / _feet I Yes .. t„ M c7
, «r / 'evvice Provider L e r Requirefi: ❑ ° °'
LOT: 9300 SW 1/4 SE 1/4 SEC. 02 T2S, R1W W.M. 1 4 / ❑ No
Al. \ ❑ Received P S, r ON SSITE
9300 SW EDGEWOOD STREET TIGARD, OREGON 97223 �ru i Cothe Sc pate: a[ IkLO9
ROOF AREA OF ADDITION ONLY: 650 S.F. :.; tN EERIN DE \ SITE PLAN
LOT AREA 40,946 S.F. —
.94 ACRES Actual Slope: % CI Approved \❑ Not Approved SHEET
Site PIA pproved O . N J 4roved O? A.0
Notes: Gt re-- o Lrs`'
r \ ,